O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 22 Introduction Since the introduction of the South African Choice on Termination of Pregnancy Act (CTOP) in 1996, there has been a substantial decrease in maternal death due to unsafe Termination of pregnancies (TOPs). 1,2 Mbele et al demonstrated a drop in mortality index for women in Pretoria West from 21.7% to 2.0% (p = 0.02, RR 0.1, 95% CI 0.01-0.89) between the timeframes of 1997-1998 and 2003–2005. Unsafe abortions were an avoidable factor in 24,8% of deaths due to miscarriage between 2014-2016, highlighting the inaccessibility and lack of acceptable and safe options for TOP for the majority of South African women. 3 Almost two thirds of women in South Africa decide to go to a traditional healer or carry out self-induced abortions for reasons including: experiencing barriers to legal service use such as nancial; not being aware of the CTOP Act and their options; not knowing of a legal facility in order to get a legal abortion early enough; and fearing maltreatment by healthcare professionals at legal facilities. 4 Stigma from one’s community and healthcare providers, as well as privacy concerns are two other factors forcing women outside of the legal system of abortion services. 5 e most common reason for one’s being denied a TOP is due to gestational age over 12 weeks. 5 ese women actively seek out other options - o en illegal and “quick solutions” found through internet searches. 5 Approximately 25% of TOPs performed in South Africa O&G Forum 2022; 32: 22-27 ORIGINAL RESEARCH Correspondence Emma Bryant email: emmaschonborn@gmail.com Accessibility and Acceptability of women receiving Medical Terminations of Pregnancy at Kalafong Provincial Tertiary Hospital Peter Farai Chigumadzi¹, Sheila Nansamba Lubega², Emma Bryant³ and Leon Snyman 4 ¹Department of Orthopaedics, Klerksdorp -Tshepong Hospital, Klerksdorp, South Africa ²Public Health Candidate, London School of Hygiene and Tropical Medicine, London, United Kingdom ³Department of Obstetrics and Gynaecology, Cert Gynaecological Oncology, University of Pretoria, Pretoria, South Africa 4 Department of Obstetrics and Gynaecology, Cert Gynaecological Oncology, University of Pretoria, Pretoria, South Africa Abstract Background : The South African Choice on Termination of Pregnancy Act was passed in 1996, legalizing a women’s right to request a termination of pregnancy. 1 Despite this legislation, there are still a large number of women who seek out unsafe abortions, with estimates as high as 50% of all abortions. 2 Barriers to accessing safe and legal abortions at designated healthcare facilities is an important public health issue. In a study by Frederico et al during the period of 2014-2016, unsafe abortions were an avoidable factor in 24,8% of deaths due to miscarriage. 3 Objectives: The aim of the study is to describe the population making use of the TOP service at Kalafong Provincial Tertiary Hospital (KPTH), to determine the accessibility and evaluate the experiences of the services provided and to evaluate the Mifepristone – misoprostol outpatient medical TOP regimen. Methods: A prospective descriptive study was conducted at the KPTHWomen’s Health Clinic (KWHC), in Atteridgeville, Pretoria between February and April 2020.A self-administered questionnaire and the interviewer-administered follow-up questionnaire were anonymously completed. Results: 245 participants completed the initial questionnaire, and 102 participants completed the follow-up questionnaire. Most of the study population were between the ages of 19 to 35 78.4% (n=193) and 9.8% (n=24 were between the ages of 16 and 18. 18.4% (n=45) of participants had a previous TOP. 9.8% (n=24)) of participants said that they do not feel safe attending the KWHC for various reasons. Prior to falling pregnant, 65.3% (n=160) of participants were not making use of any contraceptive methods. Conclusion : TOP remains a highly stigmatized topic. Comprehensive sexual health and contraceptive training, at KPTH and its feeder healthcare facilities is required to ensure a decentralization of TOP services.Youth-focused, community-based public health campaigns on safe sexual practices; appropriate timing of TOP and accessible and free contraceptive services are essential in addressing the age old need for TOP and associated maternal morbidity and mortality. Keywords : Medical termination of pregnancy, medical abortion, termination of pregnancy, safe termination of pregnancy, abortion clinic, abortion services, TOP, Mifepristone, Misoprostol